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Internal medicine_Module4_ CM2 (short tests)
Опис:
12 cеместр
Перелік питань:
1.
A.
B.
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D.
E.
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D.
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3.
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B.
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6.
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C. *
A patient with pneumonia is receiving supplemental oxygen, 2 L/min via nasal cannula. The patient’s
history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because
of these findings, the physician closely monitors the oxygen flow and the patient’s respiratory status.
Which complication may arise if the patient receives a high oxygen concentration?
Apnea
Anginal pain
Respiratory alkalosis
Metabolic acidosis
None of above
A patient with chronic obstructive pulmonary disease (COPD) and a history of coronary artery
disease is receiving aminophylline, 25mg/hour. Which one of the following findings would require
immediate intervention?
Decreased blood pressure and respirations
Flushing and headache
Restlessness and palpitations
Increased heart rate and blood pressure
None of above
A patient presents with acute exacerbation of chronic bronchitis associated with COPD. If there is
evidence of bacterial infection (e.g. purulent sputum), which of the following antibiotics would NOT
be recommended for treatment?
Ofloxacin
Macropen
Levofloxacin
Doxycycline
Vancomycine
An elderly postoperative patient has a history of chronic obstructive pulmonary disease. Based on
this history, the physician is especially concerned with monitoring the patient for which problem?
Aspiration
Delirium
Decreased gas exchange
Positioning difficulty
None of above
A homeless alcoholic with a chronic productive cough, presents with haemoptysis. The chest X-ray
shows a cavitating lesion. Choose the single most likely cause of the disease
Haemophilus influenzae
Streptococcus pneumoniae
Pneumocystis carinii
Legionella pneumoniae
Mycoplasma tuberculosis
A chronic smoker with COPD develops a fever. He reports bringing up green phlegm on coughing.
Choose the single most likely cause of the disease
Staphylococcus aureus
Streptococcus pneumoniae
Haemophilus influenzae
D.
E.
F.
G. *
H.
I.
J.
K.
7.
A. *
B.
C.
D.
E.
8.
A. *
B.
C.
D.
E.
9.
A.
B.
C.
D.
E. *
10.
A. *
B.
C.
D.
E.
11.
A.
12.
Mycoplasma tuberculosis
Chlamydia trachomatis
A 30-yr-old IV drug abuser presents with dyspnoea and haemoptysis. His CXR is unremarkable and
ECG shows sinus tachycardia with a mean P axis shift to the right. ABG shows a low PaCO2 and an
elevated pH. Pulmonary embolism was suspecteChoose the single most likely investigation
Pulmonary angiogram
Bronchography
Sputum cytology
Tissue biopsy
Urinalysis
A 50-yr-old man' presents with occasional haemoptysis and chronic productive cough. He has a
history of recurrent pneumoniCXR reveals peribronchial fibrosis. Bronchiectasis are suspected.
Choose the single most likely investigation
CT chest
12 lead ECG
Clotting studies
Sputum cytology
Urinalysis
A 32-yr-old woman who works in a pet shop complains of fever, a dry cough and increasing
breathlessness. Choose the single most likely cause of the disease
Chlamydia psittaci
Mycoplasma tuberculosis
Klebsiella pneumoniae
Staphylococcus aureus
Haemophilus influenzae
60-yr-old male non-smoker: PFTs—FEV: 4 I, FVC—5 I, FEV1/FVC—40%. After bronchodilator
trial—FEV1/FVC—50%. After 2 weeks of Prednisolone 30 mg daily FEV1/FVC = 65%. Choose the
single most likely diagnosis
Pulmonary haemorrhage
Pulmonary embolism
Chronic bronchitis
Extrinsic tracheal compression
Asthma
A 35-yr-old woman after thoracic chest injury and hemoptysis: ABG—pH 4, pCO2—4, pO2—4,
TLCO—90% of predicted, KCO—160% of predicted. All results were normal 24 hours ago. Choose
the single most likely diagnosis
Pulmonary haemorrhage
Pulmonary embolism
Chronic bronchitis
Extrinsic tracheal compression
Asthma
A 56-yr-old man wheezes and coughs. He has tried to give up smoking, but he finds it very difficult.
He is thin and healthy looking with a rounded chest. His breathing is noisy. His cough is
unproductive. Choose the single most likely management
A young male homosexual with Kaposi's sarcoma complains of increasing breathlessness and a dry
cough. Choose the single most likely cause of the disease
A.
B.
C. *
D.
E.
13.
A.
B. *
C.
D.
E.
14.
A.
B.
C. *
D.
E.
15.
A.
B. *
C.
D.
E.
16.
A. *
B.
C.
D.
E.
17.
A.
B.
C. *
D.
E.
18.
A.
Chlamydia trachomatis
Haemophilus influenzae
Pneumocystis carinii
Staphylococcus aureus
Streptococcus pneumoniae
A 30-yr-old woman has just returned from a holiday in Cyprus. She complains of a dry cough, fever,
malaise. A CXR shows patchy consolidation. Choose the single most likely cause of the disease
Streptococcus pneumoniae
Legionella pneumoniae
Haemophilus influenzae
Mycoplasma tuberculosis
Chlamydia trachomatis
Patient N., 45 y.o., has an acute onset of pneumonia with high fever and chills and rusty sputum. The
X-ray shows right lower lobe consolidation. Choose the single most likely cause of the disease
Staphylococcus aureus
Mycobacterium tuberculosis
Streptococcus pneumoniae
Pneumocystis carinii
Esherihia coli
A 26-yr-old man presents with severe shortness of breath and dry cough, which he has had for 24 hr.
He is very distressed. He has been an IV drug abuser. The X-ray shows perihilar fine mottling.
Choose the single most likely cause of the disease
Mycobacterium tuberculosis
Staphylococcus aureus
Haemophilus influenzae
Pneumocystis carinii
Legionella
Previously well 18-yr-old has had influenza for the last 2 weeks. She is deteriorating and has a
swinging fever. She is coughing up copious purulent sputum. CXR shows cavitating lesions. Choose
the single most likely cause of the disease
Staphylococcus aureus
Pneumocystis carinii
H influenzae
Streptococcus pneumoniae
Mycoplasma pneumoniae
A 64-yr-old man with COPD presents with pneumoniClinically he improves with antibiotics. In the
outpatient clinic 4 weeks later, the consolidation on his CXR has not resolved. Choose the single
most likely cause of the disease
Pneumonia
Bronchiectasis
Lung cancer
Bronchial asthma
Tuberculosis
A 52-yr-old woman on HRT presents with swollen left calf, chest pain and shortness of breath.
Choose the single most likely diagnosis
Bronchogenic carcinoma
B.
C.
D. *
E.
19.
A.
B.
C. *
D.
E.
20.
A.
B. *
C.
D.
E.
21.
A.
B.
C. *
D.
E.
22.
A. *
B.
C.
D.
E.
23.
A.
B. *
C.
D.
E.
24.
A. *
B.
C.
D.
Pulmonary oedema
Pleural effusion
Pulmonary embolism
Pneumonia
A 78-yr-old man has been short of breath for a few weeks. His chest radiography shows a right basal
shadow rising towards axilla. Choose the single most likely diagnosis
Bronchogenic carcinoma
Pulmonary oedema
Pleural effusion
Pulmonary embolism
Pneumonia
A 34-yr-old tall slim porter presents with sudden onset of chest pain and breathlessness. He has had
similar episodes in the past. Choose the single most likely diagnosis
Bronchial asthma
Pneumothorax
Pleural effusion
COPD
Pneumonia
A 76-yr-old man presents with acute breathlessness, cough, frothy blood stained sputum and
palpitations. He is apyrexial. ECG shows sinus tachycardia. Choose the single most likely diagnosis
Bronchial asthma
Pneumothorax
Pulmonary oedema
COPD
Pneumonia
A 37-yr-old man presents with dyspnoea, cough, weight loss and night sweats. His CXR shows
diffuse bilateral infiltrates. Choose the single most likely diagnosis
Chlamydia psittaci
Staphylococcus aureus
Streptococcus pneumoniae
Pneumocystis carinii
Pseudomonas aeruginosa
A 48-yr-old man presents with fever, rigors, headache and diarrhoea. He recently had been on a
holiday abroad. CXR shows consolidation. Choose the single most likely diagnosis
Staphylococcus aureus
Legionella pneumophilia
Streptococcus pneumoniae
Pneumocystis carinii
Pseudomonas aeruginosa
A 24-yr-old man with dry cough, skin manifestations and bone and muscle aches. His chest
radiograph shows widespread patchy shadows. Blood tests show evidence of haemolysis. Choose the
single most likely diagnosis
Mycoplasma pneumoniae
H. influenzae
Streptococcus pneumoniae
Pneumocystis carinii
E.
25.
A. *
B.
C.
D.
E.
26.
A.
B.
C.
D.
E. *
27.
A.
B.
C.
D. *
E.
28.
A.
B.
C.
D. *
E.
29.
A.
B.
C.
D.
E. *
30.
A. *
B.
C.
D.
E.
31.
A. *
Pseudomonas aeruginosa
A 45-yr-old farmer presents with flu-like illness anorexia and dry cough. His OCR shows patchy
consolidation. Choose the single most likely diagnosis
Mycoplasma pneumoniae
H. influenzae
Streptococcus pneumoniae
Pneumocystis carinii
Pseudomonas aeruginosa
A 41-yr-old drug abuser presents with fever, cough and breathlessness. This was preceded by viral
influenza. Chest radiograph shows multiple abscesses. Choose the single most likely diagnosis
Pseudomonas aeruginosa
H. influenzae
Streptococcus pneumoniae
Pneumocystis carinii
Staphylococcus aureus
A 24-yr-old student with cystic fibrosis rapidly deteriorated and developed acute respiratory failure
while in hospital. Choose the single most likely diagnosis
Pneumocystis carinii
H. influenzae
Mycobacterium tuberculosis
Pseudomonas aeruginosa
Streptococcus pneumoniae
A 69-yr-old woman who had a total hip replacement a week ago presents with severe chest pain,
shortness of breath and haemoptysis. Choose the single most likely diagnosis
Bronchiectasis
Bronchogenic carcinoma
Tuberculosis
Pulmonary infarction
Pneumonia
A 52-yr-old diabetic presents with fever, pleuritic pain and rusty coloured sputum. Choose the single
most likely diagnosis
Bronchiectasis
Bronchogenic carcinoma
Tuberculosis
Pulmonary infarction
Pneumonia
A 30-yr-old woman presents with fever, pharyngitis and cough. The CXR shows widespread bilateral
patchy consolidation. Erythema multiforme is present. Choose the single most likely cause of her
state
Mycoplasma
pneumoniae
Bronchial asthma
Pneumoconiosis
COPD
Pleurisy
A 35-yr-old pet shop owner presents with high fever, excruciating headache and a dry hacking cough.
The CXR shows patchy consolidation. Choose the single most likely etiology of the disease
Chlamydia psittaci
B.
C.
D.
E.
32.
A.
B. *
C.
D.
E.
33.
A. *
B.
C.
D.
E.
34.
A.
B.
C.
D. *
E.
35.
A. *
B.
C.
D.
E.
36.
A. *
B.
C.
D.
E.
37.
A.
B.
C.
D. *
Streptococcus pneumoniae
Pseudomonas aeruginosa
Actinomycosis
Staphylococcus aureus
A 70-yr-old woman presents with confusion and productive cough. CXR shows right lower lobe
consolidation. Choose the single most likely etiology of the disease
Aspergillosis
Streptococcus pneumoniae
Staphylococcus aureus
H. influenzae
Esherihia coli
A 70-yr-old alcoholic man presents with sudden onset of purulent productive cough. CXR shows
consolidations left upper lobe. Choose the single most likely etiology of the disease
Klebsiella pneumonia
Pneumocystis carinii
CMV
Chlamydia
Actinomyces
A 20-yr-old male IV drug abuser presents with breathlessness and cough. CXR reveals patchy areas
of consolidation with abscess formation. Choose the single most likely etiology of the disease
Streptococcus pneumoniae
Pneumocystis carinii
CMV
Staphylococcus aureus
Haemophilus influenzae
An 18-yr-old teenager with cystic fibrosis presents with a chest infection. Pseudomonas infection was
diagnosed.The teenager also suffers from mild renal failure. Choose the single most likely treatment
Ciprofloxacin
Rifampicin + Isoniazid
Prednisolone
Beta 2 agonist
Cyclophosphamide
A 40-yr-old mental patient with dry cough and confusion. Blood tests reveal lymphopenia and
hyponatraemia. CXR shows right lobar shadowing. Legionelia pneumonia was diagnosed. Choose
the single most likely treatment
Erythromycin
Rifampicin + Isoniazid
Prednisolone
Beta 2 agonist
Cyclophosphamide
A 23-yr-old man presents with wheezing attacks and episodic shortness of breath. His PEFR is 400
L/min. Choose the single most likely treatment
Erythromycin
Plasmaphoresis
Tetracycline
Beta 2 agonist
E.
38.
A.
B.
C. *
D.
E.
39.
A. *
B.
C.
D.
E.
40.
A. *
B.
C.
D.
E.
41.
A.
B. *
C.
D.
E.
42.
A.
B.
C. *
D.
E.
43.
A.
B. *
C.
D.
Cyclophosphamide
A 37-yr-old man who has had recurrent chest infections since a serious bout of influenza 3-yr ago
presents with chronic productive cough. His sputum is tenacious and blood stained. On auscultation
you find crackling. Choose the single most likely management
Surgical excision
Chest wall drain
Postural drainage
Salbutamol
Pleurectomy
A 18-yr-old girl has severe cough and fever. She appears acutely ill and cyanosed. Choose the single
most likely diagnosis
Respiratory syncytial virus
Bronchogenic carcinoma
Pleural effusion
Tuberculosis
Bronchiectasis
A 38-yr-old sailor presents with a dry cough of sudden onset. He complains of a chest pain and rusty
sputum. He also has a very high fever, rapid breathing, cyanosis and crepitations. Choose the single
most likely cause of his disease
Pneumococci
S. aureus
M. tuberculosis
Klebsiella
Esherihia coli
A 54-yr-old farmer with intermittent dry cough fever and dyspnoea progressive weight loss and fine
crepitations on auscultation. Extrinsic allergic alveolitis (Farmer’s lung) is suspected. Choose the
single most likely investigation
Mantoux test
Serum precipitins and high resolution CT
Fibreoptic bronchoscopy
Sputum culture
Arterial blood gases
A 30-yr-old woman presents with a 3-day history of pyrexia, rigors and sweats. This was preceded by
a 1 week history of cough and increasing dyspnoea. She had a swinging fever and dullness to
percussion at the left lung base. Choose the single most likely diagnosis
Pleural metastases
Bronchial asthma
Pneumonia
Emphysema
Cardiac failure
A 50-yr-old man became suddenly breathless whilst eating. He has marked stridor and is choking and
drooling. Foreign body obstructing bronchial airway is diagnosed. Choose the single most likely
management
Nebulised salbutamol
Heimlich manoeuvre
Rapid infusion of saline
IV Adrenaline
E.
44.
A. *
B.
C.
D.
E.
45.
A.
B.
C.
D. *
E.
46.
A. *
B.
C.
D.
E.
47.
A.
B.
C.
D. *
E.
48.
A.
B. *
C.
IV Furosemide
A 20-yr-old woman is too breathless to speak. Her pulse is 120/min respiratory rate 30/min and
PEFR is 100 l/min. Examination reveals a very quiet chest and CXR is normal. Acute asthma attack
is diagnosed. Choose the single most likely management
Nebulised salbutamol
Heimlich manoeuvre
Rapid infusion of saline
IV Adrenaline
IV Furosemide
A 36-year-old woman has had increasing dyspnea for 8 years. She has cough and increased sputum
production. On physical examination there is hyperresonance to percussion. A chest radiograph
reveals increased lung volumes with flattening of the diaphragmatic leaves bilaterally. The right heart
border is prominent. Which of the following laboratory findings is she most likely to have?
Decreased serum ceruloplasmin
Increased sweat chloride
Elevated blood ethanol
Decreased serum alpha-1-antitrypsin
Positive urine opiates
A 40-year-old woman has had a high fever for a week, accompanied by a cough productive of
yellowish sputum. On physical examination her temperature is 2 C. There are diffuse rales in all lung
fields. Her chest radiograph reveals patchy infiltrates in all lung fields, and there is a 4 cm rounded
area of consolidation in the left upper lobe that has an air-fluid level. Examination of her sputum
reveals numerous neutrophils. Which of the following infectious agents is most likely causing her
pulmonary disease?
Staphylococcus aureus
Hemophilus influenzae
Mycobacterium tuberculosis
Mycoplasma pneumoniae
Adenovirus
A 19-year-old girl has the acute onset of dyspnea and wheezing. She coughs up a large, thick mucus
plug. She has experienced similar previous episodes for the past 7 years, all of which lasted 1 to 6
hours. On physical examination her vital signs include T 1 C, P 109/minute, RR 27/minute, and BP
90/60 mm Hg. There are decreased breath sounds in all lung fields. A chest radiograph reveals
hyperinflation but no infiltrates. Laboratory studies show WBC count of 8300/microliter with
differential count of 60 segs, 3 bands, 16 lymphs, 10 monos, and 11 eosinophils. A sputum sample
examined microscopically has increased numbers of eosinophils. Which of the following is the most
Mycoplasma
pneumonia infection
likely diagnosis?
COPD
Hypersensitivity pneumonitis
Bronchial asthma
Aspiration of gastric contents
A 45 year old man who is known to be HIV positive is admitted to the medical ward with increasing
dyspnoea and a non-productive cough of 3 weeks duration. He has smoked 20 cigarettes a day for 20
years. His temperature is 38c. Breath sounds are normal. Leukocyte count was 5 x 109/L with low
neutrophil and lymphocyte count. Sputum examination is normal. Chest X-ray shows bilateral diffuse
infiltration. Which of the following is the most likely diagnosis?
Tuberculosis
Pneumocystis carinii pneumonia
Aspergillosis
D.
E.
49.
A.
B. *
C.
D.
E.
50.
A.
B. *
C.
D.
E.
51.
A.
B.
C. *
D.
E.
52.
A.
B.
C.
D. *
E.
53.
A. *
B.
C.
D.
E.
54.
Bronchiectasis
Carcinomatous infiltration of lung
A 17 year young man has clubbing, tachypnoea and hyperinflation of his chest. His temperature is 5c.
On auscultation, there are widespread crackles. He has been coughing up copious amount of thick,
green sputum for the past year. His stools are pale, offensive smelling and do not flush easily. Which
of the following is the most likely organism isolated from his sputum?
Respiratory syncytial virus
Pseudomonas sp
Streptococcus pneumoniae
Mycobacterium tuberculosis
Chlamydia pneumoniae
A 71 year old woman with a history of alcohol abuse presenting with 5 days of fever, right sided
pleuritic chest pain and coughing up rusty-coloured sputum. A sputum gram stain shows large
numbers of gram positive cocci. Which of the following pathogens is most likely to be the cause of
pneumonia?
Staphylococcus aureus
Streptococcus pneumoniae
Pneumocystis carinii
Pseudomonas aeruginosa
Legionella sp.
A 49 year old homosexual man, recently diagnosed with HIV infection admitted with a dry cough,
shortness of breath and fever. Pulse oximetry shows oxygen saturations of 86% on room air. Which
of the following pathogens is most likely to be the cause of pneumonia?
Pseudomonas aeruginosa
Streptococcus pneumoniae
Pneumocystis carinii
Influenza virus
Haemophilus influenzae .
A 23 year old man ventilated on an ICU following a head injury, showing increased oxygen
requirements, and a left sided infiltrate on a chest x-ray. A bronchial lavage specimen reveals gram
negative bacilli. Which of the following pathogens is most likely to be the cause of pneumonia?
Candida albicans
Streptococcus pneumoniae
Haemophilus influenzae
Pseudomonas aeruginosa
Staphylococcus aureus
A previously fit 46 year old man who has recently returned from a holiday in Spain, is admitted with
a dry cough, fever, abdominal pain and malaise. Initial blood tests show he is in renal failure with a
creatinine of 380imol/l and hyponatraemia with a plasma sodium of 119 mmol/l. Three other friends
who stayed in the same hotel have also developed a severe pneumonia. Which of the following
pathogens is most likely to be the cause of pneumonia?
Legionella sp.
Streptococcus pneumoniae
Haemophilus influenzae
Influenza virus
Mycobacterium tuberculosis
A 23-yr-old male patient has just returned from holiday abroad presents with flu-like illness,
headaches, high fever prior to this, he had complained of abdominal pain, vomiting, diarrhoea
associated with blood per rectum. Choose the single most likely cause of the disease
A.
B.
C.
D. *
E.
55.
A. *
B.
C.
D.
E.
56.
A.
B.
C. *
D.
E.
57.
A.
B.
C.
D. *
E.
58.
A. *
B.
C.
D.
E.
59.
A. *
B.
C.
D.
E.
Staphylococcus aureus
Streptococcus pneumoniae
H influenzae
Legionella pneumoniae
Pneumocystis carinii
A 35-yr-old previously healthy man returned from holiday five days ago. He smokes 10 cigarettes
per day. He presents with mild confusion, a dry cough and mild pyrexia. His chest is normal. The
X-ray shows widespread upper zone shadowing. Choose the single most likely cause of the disease
Legionella
Staphylococcus aureus
Haemophilus influenzae
Pneumocystis carinii
Streptococcus pneumoniae
A 65-yr-old man currently undergoing chemotherapy of chronic leukaemia has felt unwell with fever
and unproductive cough for 2 weeks despite treatment with broad-spectrum IV antibiotics. The CXR
shows an enlarging right sided mid zone consolidation. Choose the single most likely cause of the
disease
Staphylococcus aureus
Pneumocystis carinii
Fungi
Streptococcus pneumoniae
Mycoplasma pneumoniae
A 27-yr-old male prostitute has felt generally unwell for 2 months with some weight loss. Over the
last 3 weeks he has noticed a dry cough with increasing breathlessness. Two courses of antibiotics
from the GP have produced no improvement. The CXR shows bilateral interstitial infiltrates. Choose
the single most likely cause of the disease
Staphylococcus aureus
Streptococcus pneumoniae
H influenzae
Pneumocystis carinii
Mycoplasma pneumoniae
On return to university, a 20-yr-old student presented with the onset of fever, malaise and a dry
cough. The student health service gave him Amoxycilin. After a week he felt no better and his CXR
showed patchy bilateral consolidation. Choose the single most likely cause of the disease
Mycoplasma pneumoniae
Streptococcus pneumoniae
H influenzae
Pneumocystis carinii
Staphylococcus aureus
A 37-yr-old farmer presented with fever, malaise, cough and breathlessness, which he had had for a
few days. His symptoms were worse in the evening. Clinical examination demonstrated coarse end
inspiratory crackles. Choose the single most likely diagnosis
Extrinsic allergic alveolitis
Pulmonary oedema
Pleural effusion
COPD
Pneumonia
60.
A. *
B.
C.
D.
E.
61.
A. *
B.
C.
D.
E.
62.
A.
B. *
C.
D.
E.
63.
A.
B.
C. *
D.
E.
64.
A. *
B.
C.
D.
E.
65.
A. *
B.
C.
A 50-yr-old man who works in an abattoir presents with sudden onset of fever, myalgia, headache,
dry cough and chest pain. CXR shows patchy consolidation of the right lower lobe giving a ground
glass appearance. Choose the single most likely etiology of the disease
Coxiella burnetti
Streptococcus pneumoniae
Staphylococcus aureus
H. influenzae
Esherihia coli
A 44-yr-old travelling insurance salesman presents with high fever myalgia abdominal pain and
haemoptysis. CXR shows diffuse patchy lobar shadows. The cough progresses from a modest
nonproductive cough to producing mucopurulent sputum. The fever persists for 2 weeks. Choose the
single most likely etiology of the disease
Legionella pneumophilia
Streptococcus pneumoniae
Staphylococcus aureus
H. influenzae
Esherihia coli
A 42-yr-old man with AIDS presents with fever, dry cough and dyspnoe CXR shows diffuse bilateral
alveolar and interstitial shadowing beginning in the perihilar regions and spreading outward. Choose
the single most likely etiology of the disease
Streptococcus pneumoniae
Pneumocystis carinii
CMV
Staphylococcus aureus
Haemophilus influenzae
A 60-yr-old farmer presents with fever, cough and shortness of breath. He had been forking hay that
morning. CXR shows fatty nodular shadows in the upper zone. Extrinsic allergic alveolitis (Farmer’s
lung) was diagnosed. Choose the single most likely treatment
Ciprofloxacin
Rifampicin + Isoniazid
Prednisolone
Beta 2 agonist
Tetracycline
A 30-yr-old IV drug abuser presents with dyspnoea and haemoptysis. His CXR is unremarkable and
ECG shows sinus tachycardia with a mean P axis shift to the right. ABG shows a low PaCO2 and an
elevated pH. Pulmonary embolism was suspected. Choose the single most likely investigation
Pulmonary angiogram
Bronchography
Sputum cytology
Tissue biopsy
Urinalysis
A 40-yr-old man' presents with occasional haemoptysis and chronic productive cough. He has a
history of recurrent pneumoniCXR reveals peribronchial fibrosis. Bronchiectases are suspected.
Choose the single most likely investigation
CT chest
12 lead ECG
Clotting studies
D.
E.
66.
A.
B.
C.
D.
E. *
67.
A. *
B.
C.
D.
E.
68.
A.
B. *
C.
D.
E.
69.
A.
B.
C.
D. *
E.
70.
A.
B.
C.
D. *
E.
71.
Sputum cytology
Urinalysis
58-yr-old male non-smoker: PFTs—FEV: 4 I, FVC—5 I, FEV1/FVC—40%. After bronchodilator
trial—FEV1/FVC—50%. After 2 weeks of Prednisolone 30 mg daily FEVj/FVC = 65%. Choose the
single most likely diagnosis
Pulmonary hemorrhage
Pulmonary embolism
Chronic bronchitis
Extrinsic tracheal compression
Asthma
A 45-yr-old woman after thoracic chest injury and hemoptysis: ABG—pH 4, pCO2—4, pO2—4,
TLCO—90% of predicted, KCO—160% of predicted. All results were normal 24 hours ago. Choose
the single most likely diagnosis
Pulmonary haemorrhage
Pulmonary embolism
Chronic bronchitis
Extrinsic tracheal compression
Asthma
A 22-yr-old car mechanic is brought to casualty by his girlfriend. She describes a 2-day history of
rigors, sweats and intermittent confusion. On examination he is agitated, sweaty and pyrexial with 6°
C. He is hyperventilating and cyanosed despite receiving O2 by face mask. There is dullness to
percussion and bronchial breathing at the left lung base. Left lower lobe pneumonia was suspected.
Choose the single most likely investigation
Urea and electrolytes
Chest X-ray
Spiral CT with contrast
Blood count and film
ECHO
A 47-yr-old man wheezes and coughs. He has tried to give up smoking, but he finds it very difficult.
He is thin and healthy looking with a rounded chest. His breathing is noisy. His cough is
unproductive. Choose the single most likely management
Prednisolone
Amoxycillin
Postural drainage
Salbutamol
Pleurectomy
A middle-aged smoker presents with chronic cough and phlegm. His sputum is tenacious but not
yellow or blood stained. His chest is hyperinflated. His arterial carbon dioxide is high and is arterial
oxygen is low. Choose the single most likely diagnosis
Tuberculosis
Pulmonary embolism
Bronchial asthma
COPD
Pneumonia
A 43-yr-old shipyard worker complains of gasping for breath. On physical examination you discover
mild cyanosis and restricted chest movements. Respiratory distress is present. Choose the single most
likely management
A.
B.
C.
D.
E. *
72.
A.
B.
C. *
D.
E.
73.
A. *
B.
C.
D.
E.
74.
A.
B.
C. *
D.
E.
75.
A.
B.
C. *
D.
E.
76.
A.
B.
C.
D. *
E.
77.
A. *
B.
Anticoagulants
Chemotherapy
Radiotherapy
A healthy diet
Oxygen therapy
A 50-yr-old with pulmonary fibrosis develops sudden left-sided pleuritic chest pain and dyspnoea.
He has reduced air entry in the left side of the chest and percussion is hyper-resonant. O2 saturation
is 80%. Pneumothorax is diagnosed. Choose the single most likely management
Nebulised salbutamol
Heimlich manoeuvre
Pleural aspiration
High flow oxygen and anticoagulation
IV Adrenaline
An old woman complains of wheeze, dyspnoea and cough. She cannot sleep at night because of a
chronic cough. Her CXR suggests hyperinflation. Spyrography: FEV1, FVC, Typhno index are low.
What is the previous diagnosis?
COPD
Bronchogenic carcinoma
Emphysema
Respiratory failure
Bronchial asthma
A 8-yr-old girl with cystic fibrosis presents with a chest infection. The girl also suffers from mild
renal failure. Choose the most appropriate treatment
Erythromycm
Tetracycline
Ciprofloxacin
Flucoxacillin
All of the above
A 24-yr-old woman presents with a week's history of fever, rigors arid productive rusty cough. CXR
shows right lower lobe consolidation. What is the previous diagnosis?
COPD
Emphysema
Pneumonia
Bronchial asthma
Non above
A 24-yr-old woman presents with a week's history of fever, rigors arid productive rusty cough. CXR
shows right lower lobe consolidation. Prescribe treatment.
Co-trimoxazole
Prednisolone
Penicillin
Azitromycin
Non above
A 25-yr-old man has a 3-day history of shivering, general malaise and productive cough. The chest
X-ray shows right lower lobe consolidation. What is the possible diagnosis?
Pneumonia
Emphysema
C.
D.
E.
78.
A. *
B.
C.
D.
E.
79.
A.
B.
C. *
D.
E.
80.
A. *
B.
C.
D.
E.
81.
A. *
B.
C.
D.
E.
82.
A. *
B.
C.
D.
E.
83.
A. *
B.
C.
D.
COPD
Lung abscess
Respiratory failure
A 35-yr-old woman has a 3-day history of shivering, general malaise and productive cough. The
chest X-ray shows right lower lobe consolidation. What is the most possible cause of the disease?
Streptococcus pneumoniae
Mycobacterium tuberculosis
Coxiella burnetti
Pneumocystis carinii
Bacteroides fragilis
A 35-yr-old man presents with a 3-day history of pyrexia, rigors and sweats. This was preceded by a
1 week history of cough and increasing dyspnea. She had a swinging fever and dullness to percussion
at the left lung base. Previous diagnosis?
Emphysema
Tuberculosis
Pneumonia
Bronchial carcinoma
Non above
A 38-yr-old pet shop owner presents with high fever, excruciating headache and a dry hacking cough.
The CXR shows patchy consolidation. Which infection is the most possible cause of his state?
Chlamydia psittaci
Coxiella burnetti
Staphylococcus aureus
Pneumocystis carinii
Aspergillosis
A 33-yr-old man presents with dyspnoea, cough, weight loss and night sweats. His CXR shows
diffuse bilateral infiltrates. Which infection is the most possible cause of his state?
Chlamydia psittaci
Mycoplasma pneumoniae
Pneumocystis carinii
coli
Pseudomonas aeruginosa
A 31-yr-old drug abuser presents with fever, cough and breathlessness. This was preceded by viral
influenza. Chest radiograph shows multiple abscesses. Which infection is the most possible cause of
his state?
Staphylococcus aureus
Crytococcus
Streptococcus pneumoniae
Legionella pneumoniae
Mycobacterium avium
A 38-yr-old farmer presents with flu-like illness anorexia and dry cough. His CXR shows patchy
consolidation. Which infection is the most possible cause of his state?
Mycoplasma pneumoniae
Pneumocystis carinii
Chlamydia psittaci
coli
E.
84.
A. *
B.
C.
D.
E.
85.
A. *
B.
C.
D.
E.
86.
A. *
B.
C.
D.
E.
87.
A. *
B.
C.
D.
E.
88.
A. *
B.
C.
D.
E.
89.
A. *
B.
C.
D.
E.
Pseudomonas aeroginosa
A 74-yr-old woman presents with confusion and productive cough. CXR shows right lower lobe
consolidation. What is the possible cause of the disease?
Streptococcus pneumoniae
Chlamydia psittaci
Staphylococcus aureus
Pneumocystis carinii
Mycobacterium tuberculosis
A 74-yr-old woman presents with confusion and productive cough. CXR shows right lower lobe
consolidation. What is the possible diagnosis?
Pneumonia
COPD
Emphysema
Pulmonary embolism
Asthma
A chronic smoker 57 years old with COPD develops a fever. He reports bringing up green phlegm
on coughing. Which infection is the most possible cause of his state?
Haemophilus influenzae
Mycoplasma tuberculosis
Haemophilus influenzae
Pneumocystis carinii
Klebsiella pneumoniae
A young male, 25 years old, homosexual with Kaposi's sarcoma complains of increasing
breathlessness and a dry cough. The X-ray shows right lower lobe consolidation. Which infection is
the most possible cause of his state?
Pneumocystis carinii
Mycoplasma tuberculosis
Haemophilus influenzae
Chlamydia trachomatis
Klebsiella pneumoniae
Drug abuser, a 41-yr-old man, presents with fever, cough and breathlessness. This was preceded by
viral influenza. Chest radiograph shows multiple abscesses. What is the most possible etiology of
disease?
Staphylococcus
aureus
Cryptococcus
Streptococcus pneumoniae
Legionella pneumoniae
Mycobacterium avium
Drug abuser, a 47-yr-old man, presents with fever, cough and breathlessness. This was preceded by
viral influenza. Chest radiograph shows multiple abscesses. What is the most possible etiology of
disease?
Staphylococcus
aureus
Cryptococcus
Streptococcus pneumoniae
Legionella pneumoniae
Mycobacterium avium
90.
A. *
B.
C.
D.
E.
91.
A. *
B.
C.
D.
E.
92.
A.
B. *
C.
D.
E.
93.
A.
B.
C. *
D.
E.
94.
A. *
B.
C.
D.
E.
95.
A.
B.
C. *
D.
E.
96.
A.
B. *
Patient has fever, dry cough, dyspnea increases. Most of the time she lies on one side. Auscultation
and percussion data let to suspect an exudative pleurisy. What method of investigation will confirm a
diagnosis?
Chest X-ray
Pneumotachometry
Spyrometry
Bronchography
Bronchoscopy
Patient is ill with COPD for 30 years. He usually products approximately 0,5 l of purulent sputum
every day with the maximal production in the morning; fingers are like "drumsticks", nails are like
"sentinel glass". What disease is possible?
Bronchiectasis
Pneumonia
Chronic bronchitis
Gangrene of lungs
Tuberculosis
The 82-year-old patient has a pulmonary infection. Which action addresses the age-related change of
increased vascular resistance to blood flow through pulmonary vasculature in this patient?
Encouraging the patient to turn, cough, and deep breathe every hour
Assessing the patient's level of consciousness
Raising the head of the bed
Humidifying the oxygen
Non of above
Which clinical manifestation in a patient with chronic bronchitis indicates to you a worsening of the
patient's respiratory condition?
Fatigue
Cachexia
Confusion
Slow capillary refill
Non of above
A 70-yr-old alcoholic man presents with sudden onset of purulent productive cough. CXR shows
consolidations at left upper lobe. Which infection is the most possible cause of his state?
Klebsiella
Chlamydia psittacci
Staphylococcus aureus
Pneumocystis carinii
Aspergillosis
The following drug is licensed for the management of COPD:
montelukast
nedocromil sodium
salbutamol
cromolyn sodium
none of above
The following clinical features are common in COPD:
Symptoms under age 35
chronic productive cough
C.
D.
E.
97.
A. *
B.
C.
D.
E.
98.
A.
B.
C. *
D.
E.
99.
A.
B.
C.
D. *
E.
100.
A.
B.
C. *
D.
E.
101.
A.
B.
C. *
D.
E.
102.
A.
B.
C. *
D.
E.
103.
A.
B.
C. *
night time wakening with breathlessness and wheeze
significant diurnal or day to day variability of symptoms
all of above
Which laboratory results are consistent with longterm COPD?
Erythrocytosis
Erythrocytopenia
Hypocapnia
Leukopenia
Hyperglycemia
A patient has COPD and a barrel chest. Which finding would the physician expect when assessing
the chest?
Paradoxical chest movement
Presence of a friction rub
Decreased respiratory excursion
Absent breath sounds
None of above
Which would be an expected effect of resistive breathing training in a patient with COPD?
Energy conservation
Increased oxygen saturation
Decreased hypercarbia
Increased respiratory muscle strength
None of above
An elderly patient is on an anticholinergic metered dose inhaler (MDI) for chronic obstructive
pulmonary disease. The physician would suggest a spacer to
enhance the administration of the medication
increase patient compliance
improve aerosol delivery in patients who are not able to coordinate the MDI
prevent exacerbation of COPD
none of above
What is the most common cause of chronic obstructive pulmonary disease (COPD)?
Bronchiectasis
Chronic bronchitis
Cigarette smoking
Emphysema
Asthma
Alpha, 1-antitrypsin deficiency is associated with:
bronchial asthma
a late onset of dyspnea upon exertion
COPD
pneumonia
gastrointestinal malabsorption
In which of the following conditions can central cyanosis be detected?
methemoglobinemia
ventilation-perfusion mismatch
pulmonary arteriovenous fistula
D.
E.
104.
A.
B.
C. *
D.
E.
105.
A.
B.
C. *
D.
E.
106.
A.
B.
C.
D.
E. *
107.
A.
B.
C.
D. *
E.
108.
A.
B.
C. *
D.
E.
109.
A. *
B.
C.
D.
E.
110.
A. *
B.
C.
D.
E.
111.
general overcooling
heavy physical exercise
Characteristics of mediastinal emphysema include all EXCEPT:
marked suprasternal pulsation
Hamman's sign (a crackling sound synchronous with cardiac systole)
pain in the throat
gas under the diaphragm
cyanosis
Characteristics of mediastinal emphysema include all EXCEPT:
marked suprasternal pulsation
Hamman's sign (a crackling sound synchronous with cardiac systole)
arterial hypertension
gas under the diaphragm
cyanosis
The side effects of corticosteroids include all EXCEPT:
arterial hypertension
cataract
ostheoporosis
hyperglycemia
cachexy
Recognized cause of recurrent pneumonia include:
Chronic alcoholism
Multiple myeloma
Anemia
Esophageal lesions and aspiration of its content
Silicosis
Klebsiella-pneumonia:
is usually mild
is frequently associated with a collapse of the upper lobe
frequently causes lung abscesses
despite therapy the mortality is 50%
most commonly develops in youngsters
Bilateral pleural effusion is observed in all states EXCEPT:
left-sided pneumonia
sytemic lupus erythematosus
miliary tuberculosis
carcinomatous lymphangitis
chronic cardiac failure
Bilateral pleural effusion is observed in all states EXCEPT:
monolobar pneumonia
sytemic lupus erythematosus
miliary tuberculosis
severe kidney insufficiency
chronic cardiac failure
Clubbing of the fingers is observed in which of the following conditions?
A.
B.
C. *
D.
E.
112.
A.
B.
C. *
D.
E.
113.
A.
B.
C.
D. *
E.
F.
114.
A.
B.
C.
D.
E. *
115.
A. *
B.
C.
D.
E.
116.
A.
B.
C. *
D.
E.
117.
A.
B.
C.
D. *
E.
118.
A.
viral pneumonia
rheumatoid arthritis
bronchiectasis
trombemboly of pulmonary artery
status asthmaticus
Clubbing of the fingers is observed in which of the following conditions?
fungal pneumonia
rheumatoid arthritis
chronic bronchitis
trombemboly of pulmonary artery
status asthmaticus
Characteristic physical symptoms of pneumothorax include all EXCEPT:
percussion over the affected side reveals bang-box sound
auscultation over the affected side reveals weaker respiratory
sounds
end-respiratory crepitations are detected
the mediastinum is shifted towards the opposite side
there are decreased respiratory movements on the affected side
Adequate procedures in the treatment of asthmatic crisis include:
the inhalation of 40% oxygen if the PaC02 is elevated
sedation if the patient is agitated
the intravenous administration of hydrocortisone
salbutamol inhalation
plasmaphorhesis
Choose the false answer: COPD is a disease:
characterized by reversible airways obstruction
which rarely occurs in patients under the age of 35
in which symptoms rarely vary between days
which is linked to a chronic productive cough
All answers are false
Choose the false answer: When the diagnosis of COPD is considered the patient should also be
questioned about:
occupational history
dyspnoea
defecation
ankle swelling
All answers are false
Choose the false answer: Possible differential diagnosis considered when diagnosing COPD are:
lung cancer
bronchial asthma
heart failure
cystic fibrosis
All answers are false
Choose the false answer: Smoking cessation:
in patients with COPD will return the patients FEV1 to normal for their age
B.
C. *
D.
E.
119.
A.
B. *
C.
D.
E.
120.
A.
B.
C. *
D.
E.
121.
A.
B.
C.
D.
E. *
122.
A.
B.
C.
D.
E. *
123.
A.
B.
C.
D.
E. *
124.
A. *
B.
C.
D.
E.
125.
A.
B. *
in patients with COPD will return the rate of decline in FEV1 to normal
in patients with COPD will have no effect on lung function
is the most beneficial intervention for all patients with COPD
All answers are false
Choose the false answer: For management of patients with COPD it is necessary:
at severe exacerbation of COPD should be prescribed inhaled corticosteroids
admitted to hospital with an exacerbation of COPD should be scribed high dosages of oral
corticosteroids
should be referred pulmonary rehabilitation if they think that they functionally disabled by the
disease
All answers are true
All answers are false
Choose the false answer: In the management of COPD it is recommended:
the use of as required short acting inhaled beta agonists
the use of anticholinergics
the use of ipratropium and tiotropium together
the use of combination inhalers in moderate to severe disease
All answers are false
Patients with COPD should only be prescribed:
inhaled corticosteroids if they have demonstrable reversibility
corticosteroids in an exacerbation if they have had a steroid trial
ipratropium if a short acting beta agonist has shown no benefit
a long acting beta agonist if they are also receiving an inhaled corticosteroid
All answers are false
Patients with COPD demonstrate no increase in quality of life:
when prescribed inhaled corticosteroids unless they demonstrate sensibility
when prescribed tiotropium rather than ipratropium
unless their FEV1 is also increased
when prescribed a combination of inhaled corticosteroids and long-acting beta agonists
All answers are false
Patients with COPD who are prescribed long term oxygen therapy at home should:
be encouraged to stop smoking
use antibiotics at the phase of exacerbation
should avoid overcooling
should use a compressor and air to drive any nebulised medicines
All answers are true
Choose the wrong answer: Patients with COPD:
should have their nebulised drugs delivered by a nebuliser driven by oxygen
should have their nebulised drugs delivered by a nebuliser driven by air
which is severe should be prescribed a combination of an inhaled corticosteroid and long acting beta
agonist
which is moderate to severe should be prescribed tiotropium
All answers are wrong
Other therapies which have shown usefulness in the management of COPD include all exept:
mucolytics
diuretics
C.
D. *
E.
130.
theophylline
adrenomimetics
All answers are true
One of the assessment criteria which does not favour home management of exacerbations of COPD is
that the patient:
does not currently receive home oxygen therapy
severe breathlessness
has an oxygen saturation above 80%
mild breathlessness
All answers are true
All answers are true except: Abrupt withdrawal of prednisolone following management of an
exacerbation of COPD:
may precipitate a further exacerbation of COPD
is acceptable if the patient has been on a high dose for less than 21 days
can be undertaken if the patient is not on a maintenance dose of corticosteroids
cannot be undertaken if the patient is on high dose inhaled corticosteroids
All answers are true
Choose the false answer: An infective exacerbation is characterized by:
an increased volume of sputum and a cough
an increased volume of sputum and increased purulence of sputum
an increased volume of sputum and increased breathlessness
an increased volume of sputum and increased FEV1
an increased temperature
The most common causative organisms of infective exacerbations of COPD are all except:
Staphylococcus aureus
Streptococcus pneumonia
Haemophilus influenzae
All answers are false
All answers are true
An appropriate antibacterial for the management of an exacerbation of COPD are all except:
A.
B. *
amoxicillin 500mg three times a day for a non-penicillin allergic patient
amoxicillin 3g twice a day for non-penicillin allergic patients
D.
E.
126.
A.
B. *
C.
D.
E.
127.
A.
B.
C.
D. *
E.
128.
A.
B.
C.
D. *
E.
129.
A.
B.
C.